Effect of COVID-19 lockdown on maternity care and maternal outcome in the Netherlands: a national quasi-experimental study

Objectives: The COVID-19 pandemic and associated lockdowns disrupted health care worldwide. High-income countries observed a decrease in preterm births during lockdowns, but maternal pregnancy–related outcomes were also likely affected. This study investigates the effect of the first COVID-19 lockdown (March–June 2020) on provision of maternity care and maternal pregnancy–related outcomes in the Netherlands. Study design: National quasi-experimental study. Methods: Multiple linked national registries were used, and all births from a gestational age of 24+0 weeks in 2010–2020 were included. In births starting in midwife-led primary care, we assessed the effect of lockdown on provision of care. In the general pregnant population, the impact on characteristics of labour and maternal morbidity was assessed. A difference-in-regression-discontinuity design was used to derive causal estimates for the year 2020. Results: A total of 1,039,728 births were included. During the lockdown, births to women who started labour in midwife-led primary care (49%) more often ended at home (27% pre-lockdown, +10% [95% confidence interval: +7%, +13%]). A small decrease was seen in referrals towards obstetrician-led care during labour (46%, −3% [−5%,−0%]). In the overall group, no significant change was seen in induction of labour (27%, +1% [−1%, +3%]). We found no significant changes in the incidence of emergency caesarean section (9%, −1% [−2%, +0%]), obstetric anal sphincter injury (2%, +0% [−0%, +1%]), episiotomy (21%, −0% [−2%, +1%]), or post-partum haemorrhage: >1000 ml (6%, −0% [−1%, +1%]). Conclusions: During the first COVID-19 lockdown in the Netherlands, a substantial increase in homebirths was seen. There was no evidence for changed available maternal outcomes, suggesting that a maternity care system with a strong midwife-led primary care system may flexibly and safely adapt to external disruptions

fisheries and tourism social economic and ecological trade offs in coral reef systems

Coastal communities are exerting increasingly more pressure on coral reef ecosystem services in the Anthropocene. Balancing trade-offs between local economic demands, preservation of traditional values, and maintenance of both biodiversity and ecosystem resilience is a challenge for reef managers and resource users. Consistently, growing reef tourism sectors offer more lucrative livelihoods than subsistence and artisanal fisheries at the cost of traditional heritage loss and ecological damage. Using a systematic review of coral reef fishery reconstructions since the 1940s, we show that declining trends in fisheries catch and fish stocks dominate coral reef fisheries globally, due in part to overfishing of schooling and spawning-aggregating fish stocks vulnerable to exploitation. Using a separate systematic review of coral reef tourism studies since 2013, we identify socio-ecological impacts and economic opportunities associated to the industry. Fisheries and tourism have the potential to threaten the ecological stability of coral reefs, resulting in phase shifts toward less productive coral-depleted ecosystem states. We consider whether four common management strategies (unmanaged commons, ecosystem-based management, co-management, and adaptive co-management) fulfil ecological conservation and socioeconomic goals, such as living wage, job security, and maintenance of cultural traditions. Strategies to enforce resource exclusion and withhold traditional resource rights risk social unrest; thus, the coexistence of fisheries and tourism industries is essential. The purpose of this chapter is to assist managers and scientists in their responsibility to devise implementable strategies that protect local community livelihoods and the coral reefs on which they rely

The Sustainable Catch-22: An assessment of sustainability in the Dutch pension sector

The relation between financial performance and sustainability in the global pension sector has been widely researched. Current research confirms that sustainable investments can have a positive influence on financial performance, but how that effect materializes is still debated. This study argues that the ambiguity concerning this positive impact is caused by a lack of integration of sustainability in organizations. This lack of integration causes the sustainability efforts to harm financial performance of the pension funds. Nevertheless, research shows that, if sustainability is integrated in the core logic of the organization, sustainability efforts do not yield lower returns. We assess the current level of sustainability integration in the Dutch pension fund sector using a multiple case study approach. Next, this study formulates the challenges related to sustainability integration in the sector, after which solutions to the specific problems are presented. Given the lack of integration, the barriers for increasing sustainability integration can be viewed as a Catch-22. First, a perceived separation is observed between the societal pressure to invest sustainably and constituents’ pressure to realize financial value. Second, pension funds are ill equipped for the complexity in sustainable investing and use a third party as investment manager, creating a dispersion of knowledge of sustainable investments and the responsibility to do so. To be able to solve the Catch-22 dilemma, greater collaboration, standardization and a sustainability vision are needed, resulting in a positive impact on sustainability and positive effects on financial return

Ervaringen van scholen voor speciaal onderwijs en begeleiders met het zelfevaluatiekader (ZEK)

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